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During the COVID pandemic, healthcare workers faced risks to their health. The NHS advised that all high-risk workers should have a personal risk assessment to minimise the risks they faced. However, some felt that risk assessments and recommendations were not taken seriously. Research found that those from ethnic minorities felt the risks more keenly than their White colleagues.

The UK-REACH study interviewed healthcare workers about the risks they experienced during the pandemic. All felt that their work put them at risk of infection. Healthcare workers from ethnic minorities and their families were concerned that their ethnicity increased their risk.

Staff from all ethnicities described the steps they took to reduce their risk. For example, some bought their own personal protective equipment (such as face masks and gloves) or changed their living arrangements to protect family members from infection.

The researchers hope that this work will encourage policymakers to improve the management of risks faced by workers in future.  

NHS England issued a statement on the impact of COVID-19 on minority ethnic staff.

The issue: The risk to healthcare workers during the pandemic

The NHS employs clinical and non-clinical staff (such as cleaners, chefs, and porters); other healthcare professionals (such as pharmacists and opticians) work in the community. People working in healthcare settings were more exposed to COVID-19 and at higher risk of infection, intensive care admission and death, than the general public.

During the pandemic, healthcare workers from ethnic minorities in the UK accounted for 64% of deaths of nursing and support staff, and 95% of medical staff. The NHS advised that high-risk staff (including those from ethnic minorities) should have a risk assessment and arrangements made to reduce risks to their health. Many were not satisfied with the assessments.

This study investigated the risks experienced during the pandemic by NHS staff from a range of ethnicities. This study was part of the UK-REACH project, which investigates if, how, and why, ethnicity affects NHS staff’s risk of COVID-19 infection.

What’s new?

The study included 84 healthcare workers a range of professions, experience, ages, and migration statuses. The three largest ethnic groups were Asian (39%), White (27%), and Black (20%). Almost 85% lived in England (rather than Scotland, Wales or Northern Ireland), and only a few were non-clinical workers with low-paid jobs.

The researchers explored the risks they experienced during the pandemic, and if and how ethnicity affected these risks. Analysis revealed five main themes.

  1. Ethnicity. Interviewees were aware that people from ethnic minorities were at greater risk of illness or death. One interviewee said, “I was actually quite worried about getting it … there were signs that… people of colour were being affected quite a bit.” Their friends and family shared this concern. Some said that people from ethnic minorities were discriminated against in the workplace, and that discrimination had led to delays in risk assessments.

  2. Risk assessments. These ranged from informal discussions to meetings with documentation. For some people, actions were taken immediately to reduce risks to their health. For others, no action was taken. One interviewee said: “I had to email our Trust to say, “Is there going to be a risk assessment?” And then when one came out…it was quite wishy-washy.” Some risk assessments did not consider family members shielding. Staff could feel self-conscious about extra attention because of their ethnicity.

  3. Personal protective equipment. Staff from all ethnicities felt that inadequate personal protective equipment put them, their families, and patients at risk. Some were asked to re-use equipment, or to use expired face masks. Ambiguous and ever-changing guidelines made healthcare workers feel unsafe. Twice as many staff from ethnic minorities (68%) as White British staff (33%) thought there was a lack of personal protective equipment during the early days of the pandemic. This made some staff from ethnic minorities feel deprioritised and “put in harm’s way.”

  4. Staff management. Moving staff between wards and the need to self-isolate led to staff shortages. Healthcare workers with fewer health risks felt they had to take on additional shifts. Some staff said that people from ethnic minorities were more likely to work longer shifts. Interviewees sometimes had to continue working, despite being high-risk. Understaffing and busy wards could mean that it was difficult to follow safety protocols, such as changing masks between patients. One interviewee described being moved onto a COVID-19 ward: “I thought I was going to faint because I was so overwhelmed, and I’d never felt like that before.”

  5. Personal risk management. Interviewees took actions to reduce their risk. Many washed or changed out of their work clothes before entering their house. Some protected family members by moving out: “I moved into an apartment for 3 months”. Many bought their own personal protective equipment when hospital supplies were short, and some stopped using public transport to prevent infecting the public.

Why is this important?

All healthcare workers faced risks during the pandemic, but these risks were felt more keenly by people from ethnic minorities. Interviewees felt that some risks were due to racism embedded in the healthcare system. The researchers hope that this work will encourage policymakers to improve how the risks faced by staff are assessed and managed in future.  

Some of the researchers were from diverse ethnic groups, which helped interviewees talk more easily about issues related to ethnicity. The study team encourages other researchers to include diverse groups in research to ensure frank and open discussions about racism.   

NHS staff should be protected from harm not only for their own benefit but also to safeguard the nation’s health, the study concludes.

What’s next?

Many people felt that risk assessments were a box-ticking exercise. Staff came under pressure to continue working in environments in which they did not feel safe, which eroded trust in their employers. Staff safety is an employer’s responsibility, the researchers say, and thorough risk assessments and follow-up are needed to keep staff safe.

Interviewees from ethnic minorities were most concerned about their risk of becoming seriously ill once infected. The researchers say that better communication is needed at a national and organisational level to make sure individual staff are well-informed about the complex nature of risks faced by ethnic minority groups.

Further research by the same team is exploring how multiple characteristics of an individual influences the risks they faced. The researchers are analysing how overlapping characteristics (such as being a man in a low-paid job) interacted to increase risk. Better understanding of overlapping characteristics should influence both research and policy, they say.

You may be interested to read

This Alert is based on: Qureshi I, and others. Healthcare Workers From Diverse Ethnicities and Their Perceptions of Risk and Experiences of Risk Management During the COVID-19 Pandemic: Qualitative Insights From the United Kingdom-REACH Study. Frontiers in Medicine 2022;9:930904.

UK-REACH research on access to personal protective equipment among healthcare workers from diverse ethnic backgrounds: Martin CA, and others. Access to personal protective equipment in healthcare workers during the COVID-19 pandemic in the United Kingdom: results from a nationwide cohort study (UK-REACH). BMC Health Services Research 2022;22:867.

A commentary from the authors about the need to consider overlapping characteristics that may impact people’s health and wellbeing in the context of COVID: Qureshi I, and others. Intersectionality and developing evidence-based policy. Lancet 2022;399:355-356

Funding: The study was funded by the NIHR-UK Research and Innovation COVID-19 rapid response initiative

Conflicts of Interest: The study authors declare no conflicts of interest.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.

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